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  Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 53  |  Issue : 4  |  Page : 478-482
 

Tumors and tumor-like conditions of the nasal cavity, paranasal sinuses, and nasopharynx: A study of 206 cases


1 Department of Pathology, Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Haryana, India
2 Department of Pathology, Prathima Institute of Medical Sciences, Karimnagar, Telangana, India

Date of Web Publication21-Apr-2017

Correspondence Address:
RN Satarkar
Department of Pathology, Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijc.IJC_551_16

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 » Abstract 

INTRODUCTION: The nasal cavity, paranasal sinuses, and nasopharynx though in continuity form a complex system of upper respiratory tract; this region is endowed with a variety of elements such as epithelial, glandular, lymphoid, cartilage, and bone and is also exposed to a variety of infections, tumor-like and true neoplastic conditions. AIMS AND OBJECTIVES: To find out the frequency of various tumors and tumor-like conditions of the nasal cavity, paranasal sinuses, and nasopharynx. MATERIALS AND METHODS: The present study is an analysis of 206 tumors and tumor-like conditions of the nasal cavity, paranasal sinuses, and nasopharynx diagnosed during a period of 5 years. RESULTS: The patients' age ranged from 14 months to 85 years. Benign lesions were predominant in the second and third decades, with 30 cases (68.1%) occurring in that age group. Malignancies occurred predominantly in the sixth and seventh decades with 28 (60.9%) cases in this age group. Benign lesions in the nasopharynx comprised 75% cases and malignancies 25%. Eighty-three (71.5%) tumor-like conditions occurred in the nose and antrochoanal region. CONCLUSION: Angiofibroma was the most common benign tumor accounting for 25.55% of all neoplastic lesions. Squamous cell carcinoma was the most common malignancy at this site constituting 50% of all malignancies.


Keywords: Angiofibroma, carcinoma, nasal cavity, nasopharynx


How to cite this article:
Satarkar R, Srikanth S. Tumors and tumor-like conditions of the nasal cavity, paranasal sinuses, and nasopharynx: A study of 206 cases. Indian J Cancer 2016;53:478-82

How to cite this URL:
Satarkar R, Srikanth S. Tumors and tumor-like conditions of the nasal cavity, paranasal sinuses, and nasopharynx: A study of 206 cases. Indian J Cancer [serial online] 2016 [cited 2017 Dec 12];53:478-82. Available from: http://www.indianjcancer.com/text.asp?2016/53/4/478/204780



 » Introduction Top


The nasal cavity, paranasal sinuses, and nasopharynx though in continuity form a complex system of upper respiratory tract; this region is endowed with a variety of elements such as epithelial, glandular, lymphoid, cartilage, and bone and is also exposed to a variety of infections, tumor-like and true neoplastic conditions. The nose develops from the frontonasal process, which grows between the primitive forebrain and the stomatodeum. Olfactory placodes on the frontonasal process soon sink below to form nasal pits, which ultimately form the nasal cavity. Primitive nasal septum divides the nasal cavity at the middle.

Paranasal sinuses appear as diverticula from the nasal cavity, which ultimately invade the bones after which they are named. The maxillary and sphenoid sinuses begin to develop before birth. The other sinuses develop after birth.


 » Materials and Methods Top


The present study is an analysis of 206 tumors and tumor-like conditions of the nasal cavity, paranasal sinuses, and nasopharynx diagnosed during a period of 5 years from January 1, 2002, in the Department of Pathology, Government Medical College, and Hospital, Aurangabad. In the retrospective cases, the available clinical and pathological records were thoroughly reviewed. The prospective cases comprised those who were admitted to the ear, nose, and throat ward with a clinical diagnosis of tumor or tumor-like conditions of the sinonasal and nasopharyngeal region, irrespective of age and sex.


 » Results Top


Surgico-pathological specimens obtained from 206 patients with tumor and tumor-like conditions of the nasal cavity, paranasal sinuses, and nasopharynx admitted to the ear, nose and throat ward of Government Medical College and Hospital, Aurangabad, were subjected to histopathological evaluation according to the WHO classification 1978, in the Department of Pathology, Government Medical College and Hospital, Aurangabad.

The specimens obtained were either biopsies, curettings, excised masses, or resected growths. Clinically, benign appearing lesions such as papillomas, vascular tumors, and polyps were excised [Table 1]. Punch biopsies and incisional biopsies were conducted in those lesions, which were suspicious of malignancy. Resected growths comprised those which were conducted to restrict the further spread of the tumor or as a part of palliative treatment.
Table 1: Nature of specimen obtained

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Tumor-like conditions (56.4%) were more common than tumors (43.6%) at this site [Table 2].
Table 2: Frequency of tumors and tumor-like conditions

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The patients' age ranged from 14 months to 85 years. Benign lesions were predominant in the second and third decades with 30 cases (68.1%) occurring in that age group. Malignancies occurred predominantly in the sixth and seventh decades with 28 (60.9%) cases in this age group. Out of the 116 tumor-like lesions, 71 (61.2%) occurred in the second and third decades predominantly [Table 3].
Table 3: Distribution of various cases according to age

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[Table 3] shows that the maximum number of benign lesions occurred in the nose, constituting 24 (75.0%) of the total lesions occurring in the nose. Eighty-one percent of the paranasal sinuses lesions were malignant. The ratio of benign to malignant lesions in the nose was 3:1 while in the paranasal sinuses was 1:4.2. About 73.8% of the sinonasal malignancies occurred in the maxillary antrum.

Benign lesions in the nasopharynx comprised 75% cases and malignancies 25%. Eighty-three (71.5%) tumor-like conditions occurred in the nose and antrochoanal region.

Malignancies of nasal cavity, paranasal sinuses, and nasopharynx constituted 1.27% of all malignancies reported at the Government Medical College and Hospital, Aurangabad, during the study. Frequency of sinonasal malignancies was 1.16% while that of nasopharyngeal malignancy was 0.11%.

Out of 46 (100%) malignancies reported, 42 (91.3%) were of sinonasal origin, and in 4 (8.7%), nasopharynx was the primary site of origin [Table 4].
Table 4: Site-wise distribution of various lesions in the present study

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[Table 5] shows the total number of malignancies of nasal cavity and paranasal sinuses as 42, of which 36 were epithelial, 3 nonepithelial, and 3 miscellaneous. Among the epithelial malignancies, squamous cell carcinoma was most common with 20 cases. Among the three nonepithelial malignancies, one case was of embryonal rhabdomyosarcoma, one of inflammatory myofibroblastic sarcoma, and one of chondrosarcoma [Table 5]. Male constituted 23 out of 42 cases, suggesting a male preponderance.
Table 5: Frequency and sex distribution of various histological types of malignant tumors in the nasal cavity and paranasal sinuses

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 » Discussion Top


Among the 206 cases analyzed, 90 tumors and 116 tumor-like lesions were diagnosed. [Table 6] compares the total number and percentage of tumors and tumor-like conditions of nasal cavity, paranasal sinuses, and nasopharynx diagnosed during various studies conducted.
Table 6: Comparison with other studies

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The proportion of tumors reported at Government Medical College, Aurangabad, in the present study (43.6%) is less as compared to the percentage in the studies by Ghosh and Bhattacharya (1966) and Mathew (1996).

Among 90 cases reported as tumors, 44 were benign lesions and 46 were of malignancies. The comparison of the frequency of benign and malignant lesions reported in different studies is shown in [Table 7].
Table 7: Comparison with other studies

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The percentage of malignant lesions of the nasal cavity, paranasal sinuses, and nasopharynx, reported at Government Medical College, Aurangabad, between “January 2002 and December 2006,” is relatively higher as compared to other studies but is still less than the percentage of these malignancies reported at Government Medical College, Aurangabad, in 1996.

In the present study, benign tumors of the nasal cavity, paranasal sinuses, and nasopharynx were predominant in the second and third decades with 68.1% (30) cases occurring in this age group. These findings correlate with those of Ghosh and Bhattacharya, who reported that 59.4% (22) cases occurred in the second and third decades. Mathew reported 56.5% (13) cases occurring in the second and third decades.

The malignant lesions were predominant in the sixth and seventh decades with majority (60.9% {28}) cases occurring in this age group in the present study. Frazell and Lewis [7] and Ghosh and Bhattacharya reported that majority of malignancies at this site occur in the fifth to seventh decades, with which the findings of the present study correlate. Chaturvedi et al.[8] had reported the most common age group affected be 51–60 years having 43.8% cases.

The tumor-like lesions were predominant in the second and third decades in the present study; 61.2% of 116 lesions diagnosed occurred in this age group. Ghosh and Bhattacharya reported a maximum number of tumor-like lesions in the second and third decades. Tondon et al. reported the incidence of inflammatory lesions as maximum in 20–29 years. Findings in the present study are in agreement with those in the above studies.

It is difficult to determine the primary site of origin of the malignant tumors of the nose and paranasal sinuses because these sites are complexly related with each other and the adjacent structures. When cancer arises in this region, it is prone to overgrow its natural boundaries so that at the time of diagnosis it is rarely confined to a single set of air cells. Thus, an accurate determination of the site of origin is difficult and sometimes impossible.

Maxillary sinus was the most common involved site (73.8%) in the present study, followed by the nasal cavity (19%). This is in comparison with Jackson et al.,[9] Cheng and Wang,[10] and Chaturvedi et al.
Figure 1: (a) Gross specimen of maxillectomy. (b) Section showing increased cell layers with loss of polarity – transitional cell carcinoma (H and E, ×100)

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Figure 2: (a) Clinical photograph showing nasal mass. (b) Section showing features of undifferentiated carcinoma (H and E, ×400)

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Figure 3: (a and b) Section showing features of chondrosarcoma (a: H and E, ×100 and b: H and E, ×400)

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Figure 4: (a) Clinical photograph of black nasal mass. (b) Section showing features of melanoma (H and E, ×100)

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The number of benign lesions reported in the nasopharynx was 75% (12 cases) and malignancies 25% (4 cases). Ghosh and Bhattacharya reported 75% of nasopharyngeal tumors in their study as malignant and 25% as benign. The findings in the present study are consistent with their study.

Tumor-like conditions occurred predominantly in the nose and antrochoanal region comprising 71.5% (83 cases) cases. Only two tumor-like conditions were reported in the nasopharynx. This is in accordance with the findings of Ghosh and Bhattacharya, who reported 75% of tumor-like lesions in the nose.


 » Conclusion Top


Tumors and tumor-like lesions of the nose, paranasal sinuses, and nasopharynx are relatively uncommon, so it is difficult for one institution or person to accumulate a sufficient number of cases and draw meaningful conclusions with true incidence figures. Pooling of cases from a limited number of centers following a standard classification with special interest in these lesions would allow better comparison of results and suggest alternate modalities of diagnosis and treatment. Studies of this kind are, however, valuable when presenting relative frequency figures and may serve as sources of information while writing a comprehensive survey of this complex problem.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 » References Top

1.
Ghosh A, Bhattacharya K. Nasal and nasopharyngeal growth a ten year's survey. J Indian Med Assoc 1966;47:13-8.  Back to cited text no. 1
    
2.
Tondon PL, Gulati J, Mehta N. Histological study of polypoidal lesions in the nasal cavity. Indian J Otolaryngol 1971;23:3-11.  Back to cited text no. 2
    
3.
Mathew J. A Clinicopathological Study of Tumour & Tumour Like Conditions of Nasal Cavity, Paranasal Sinuses and Nasopharynx. A Thesis Presented to Dr. Babasaheb Ambedkar University, Aurangabad; 1996.  Back to cited text no. 3
    
4.
Eggston AA, Wolff D. Histopathology of the Ear, Nose & Throat. Baltimore: The William and Wilkins Company; 1947. p. 816.  Back to cited text no. 4
    
5.
Harrison DF. Scott Brown's Diseases of the Ear, Nose and Throat. 3rd ed. Vol. 3. Hodder Arnold; 1971. p. 300.  Back to cited text no. 5
    
6.
Bhople KS, Rathod R. Tumours of nose, paranasal sinuses and nasoharynx. A clinicopathological study. Indian Med Gaz 1992;76:177-85.   Back to cited text no. 6
    
7.
Frazell EL, Lewis JS. Cancer of the nasal cavity and accessory sinuses. A report of the management of 416 patients. Cancer 1963;16:1293-301.  Back to cited text no. 7
    
8.
Chaturvedi VN, Raizada RM, Jain SK, Hariharan KK, Pakhan AJ. A profile of the malignant tumours of the paranasal sinuses (a study of 57 cases). Indian J Cancer 1986;23:14-20.  Back to cited text no. 8
    
9.
Jackson RT, Fitz-Hugh GS, Constable WC. Malignant neoplasms of the nasal cavities and paranasal sinuses: (A retrospective study). Laryngoscope 1977;87:726-36.  Back to cited text no. 9
    
10.
Cheng VS, Wang CC. Carcinomas of the paranasal sinuses: a study of sixty-six cases. Cancer 1977;40:3038-41.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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